Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group.
OBJECTIVE
Few published reports describe nutrition provision for critically ill children and young adults with acute kidney injury receiving continuous renal replacement therapy. The goals of this study were to describe feeding practices in pediatric continuous renal replacement therapy and to evaluate factors associated with over- and under-prescription of protein and calories.


METHODS
Retrospective database study.


METHODS
Multicenter study in pediatric critical care units.


METHODS
Patients with acute kidney injury (estimated glomerular filtration rate < 75 mL/min/1.73 m at continuous renal replacement therapy initiation) enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy Registry.


METHODS
None.


METHODS
Nutrition variables: initial and maximal protein (g/kg/day) and caloric (kcal/kg/day) prescription and predicted resting energy expenditure (kcal/kg/day). We determined factors predicting initial and maximal protein and caloric prescription by multivariate analysis.


RESULTS
One hundred ninety-five patients (median [interquartile range] age = 8.1 [12.8] yrs, 56.9% men) were studied. Mean protein and caloric prescriptions at continuous renal replacement therapy initiation were 1.3 +/- 1.5 g/kg/day (median, 1.0; range, 0-10) and 37 +/- 27 kcal/kg/day (median, 32; range, 0-107). Mean maximal protein and caloric prescriptions during continuous renal replacement therapy were 2.0 +/- 1.5 g/kg/day (median, 1.7; range, 0-12) and 48 +/- 32 kcal/kg/day (median, 43; range, 0-117). Thirty-four percent of patients were initially prescribed < 1 g/kg/day protein; 23% never attained > 1 g/kg/day protein prescription. By continuous renal replacement therapy day 5, median protein prescribed was > 2 g/kg/day. Protein prescription practices differed substantially between medical centers with 5 of 10 centers achieving maximal protein prescription of > 2 g/kg/day in > or = 40% of patients. Caloric prescription exceeded predicted resting energy expenditure by 30%-100%. Factors independently associated with maximal protein and caloric prescription while on continuous renal replacement therapy were younger age, initial protein and caloric prescription and number of continuous renal replacement therapy treatment days (p < 0.05).


CONCLUSIONS
Protein prescription in pediatric continuous renal replacement therapy may be inadequate. Inter-center variation exists with respect to nutrition prescription. Feeding practice standardization and research in pediatric acute kidney injury nutrition are essential to begin providing evidence-based feeding recommendations.
Zappitelli
Michael
M
Baylor College of Medicine, Houston, TX, USA. mzaprdr@yahoo.ca
Goldstein
Stuart L
SL
Symons
Jordan M
JM
Somers
Michael J G
MJ
Baum
Michelle A
MA
Brophy
Patrick D
PD
Blowey
Douglas
D
Fortenberry
James D
JD
Chua
Annabelle N
AN
Flores
Francisco X
FX
Benfield
Mark R
MR
Alexander
Steven R
SR
Askenazi
David
D
Hackbarth
Richard
R
Bunchman
Timothy E
TE
D058186:Acute Kidney Injury / Q000178:diet therapy / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016014:Linear Models; D008297:Male; D018529:Nutritional Support / Q000379:methods*; D012042:Registries; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D055815:Young Adult
D004044:Dietary Proteins